Web 2.0 Education for Dose Calculation: An RCT

Background: Medication administration is among the nursing practices with the highest risk of error, and preventable medication-related harm creates a substantial clinical and economic burden worldwide. Nursing education plays a decisive role in equipping students with the mathematical knowledge and calculation skills required for safe medication management; however, studies indicate that students often perform at moderate or insufficient levels in dose calculation. Web 2.0 technologies - interactive, participation-oriented digital tools that support collaborative learning - have been increasingly integrated into nursing education, yet evidence on their effectiveness specifically for medication dose calculation competency remains limited.

Design:This study is a randomized controlled trial with a posttest-only design, conducted with first-year nursing students. A posttest-only design was chosen because participants received their first formal instruction on medication dose calculation within the scope of this study and had no prior knowledge of the topic. The study is reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guideline.

Setting and Participants:The study was conducted between February 2025 and April 2025 in the nursing department of a university in Istanbul, Türkiye. Inclusion criteria were: being a first-year nursing student admitted through the national university entrance examination, being enrolled in the Fundamentals of Nursing course, having no prior experience with Web 2.0-supported education, and being an active smartphone user. Eligible students were randomly allocated to the intervention or control group using an online random team generator. Four students (two per group) who could not maintain attendance were excluded, and the study was completed with a final sample of 96 students (intervention: n=49; control: n=47). A post-hoc power analysis using G*Power (effect size 0.60, alpha 0.05) yielded a statistical power of 88.59%.

Intervention Group: Students received a two-hour medication dose calculation education delivered through Web 2.0 tools, structured across pre-education, in-education, and post-education phases. Before the session, a digital education brochure prepared with Canva and a quiz-format assignment created on Quizizz were shared with the students, following a 15-20 minute orientation to the Web 2.0 tools. The theoretical instruction was delivered through Miro, an interactive shared-board concept-mapping tool. Following the theoretical instruction, three educational games of progressively increasing difficulty were implemented via Wordwall ("Find the Match," "Gameshow," and "Win or Lose"), and the three highest-scoring students received certificates and rewards. After the theoretical education, students received one hour of medication preparation skills training in the professional skills laboratory based on the "10 rights" of medication administration. The posttest knowledge assessment was administered via Socrative, and the scales were completed through Google Forms.

Control Group:Students received a two-hour theoretical education with identical curriculum content delivered through traditional lecture-based instruction, preceded by a paper-based preparatory assignment. The content covered the concept of medication dose, the importance of dose calculation for patient safety, the nurse's role and responsibilities, conversion of basic units of measurement, ratio-proportion, calculation of dose amounts, drop-rate calculation, weight-based dosing, dose calculations for different drug forms, and dry powder volume calculation. Students subsequently received one hour of medication preparation skills training in the professional skills laboratory based on the "10 rights" of medication administration. All posttest instruments were completed in paper-and-pencil format.

Outcome Measures: Medication dose calculation knowledge was measured with a 10-item scenario-based multiple-choice knowledge test developed from the literature, reviewed by five nursing experts (content validity index: 0.96), piloted with six students, and demonstrating a Kuder-Richardson 20 coefficient of 0.68. Medication dose calculation skill was assessed in the professional skills laboratory using two three-stage evaluation forms (tablet and ampoule/vial), scored on a standardized 0-100 scale (content validity indexes: 0.96 and 0.95, respectively; Cronbach's alpha: 0.72). During the skill assessment, each student randomly selected a numbered card corresponding to a case scenario (content validity index: 0.97) and a treatment tray, calculated the dose, prepared the medication according to standard preparation steps, and labeled it according to instructions; performance was rated by education and development nurses using the skill evaluation form. Perceived learning was measured with the 9-item Perceived Learning Scale (cognitive, affective, and psychomotor subdimensions; total score range 9-63; Cronbach's alpha in this study: 0.76). Instructional material motivation was measured with the 14-item unidimensional Instructional Material Motivation Scale (total score range 14-70; Cronbach's alpha in this study: 0.92).

Statistical Analysis: Data were analyzed using IBM SPSS Version 22.0. Descriptive statistics were used for participant characteristics. As skewness and kurtosis coefficients were within ±2, parametric tests were applied: Student's t-test and one-way analysis of variance with Bonferroni correction for group comparisons, and Pearson correlation analysis for relationships between variables. Statistical significance was set at p < 0.05.

Ethical Considerations: The study protocol was approved by the Non-Interventional Research Ethics Committee of Istanbul Medipol University (E-10840098-202.3.02-7806). Written institutional permission and written informed consent from all participants were obtained.

Inclusion criteria

• Being a first-year nursing student admitted through the national university entrance examination
• Being enrolled in the Fundamentals of Nursing course
• Having no prior experience with Web 2.0-supported education
• Being an active smartphone user

Exclusion criteria

• Failure to attend all stages of the study